磁共振动脉自旋标记成像在2型糖尿病肾功能损伤及分期中的应用价值  

Application of ASL in renal function injury and staging of T2DM

作　　者：刘键 吴瑜 徐敏[1] 张训兰 陈恒志 王荣品[1] 曾宪春[1] LIU Jian;WU Yu;XU Min;ZHANG Xunlan;CHEN Hengzhi;WANG Rongpin;ZENG Xianchun(Department of Medical Imaging,Guizhou Provincial People's Hospital,Guiyang 550002,China)

机构地区：[1]贵州省人民医院医学影像科,贵阳550002

出　　处：《磁共振成像》2023年第11期90-96,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金项目(编号:82060314)。

摘　　要：目的探讨动脉自旋标记(arterial spin labeling,ASL)成像定量评估2型糖尿病(type 2 diabetes mellitus,T2DM)肾脏血流灌注与肾功能损伤的相关性和临床应用价值。材料与方法前瞻性招募不同程度肾功能损伤的T2DM患者,根据有无蛋白尿及估算肾小球滤过率(estimated glomerular filtration rate,eGFR)值将其分组:A组,T2DM患者,无蛋白尿;B组,出现蛋白尿且eGFR≥60 mL/(min·1.73 m^(2)),即糖尿病肾病(diabetic kidney disease,DKD)Ⅰ~Ⅱ期;C组,15 mL/(min·1.73 m^(2))≤eGFR<60 mL/(min·1.73 m^(2)),即DKDⅢ~Ⅳ期。同时纳入健康志愿者作为对照组。行双肾常规MRI平扫及ASL扫描获取双侧肾皮质肾血流量(renal blood flow,RBF)值,同时收集肾功能及尿常规等生化指标,分析各组肾皮质RBF值的差异性,以及相关指标的相关性、敏感性及最佳诊断阈值等。结果左肾与右肾肾皮质RBF值差异无统计学意义(P均>0.05)。四组受试者肾皮质RBF值总体差异具有统计学意义(P均<0.001)。进一步两两比较:与对照组相比,A、B、C组肾皮质RBF值明显降低(P均<0.05),对照组为(174.28±23.89)mL/(100 g·min),A组降低为(159.66±28.54)mL/(100 g·min),B组降低为(142.16±19.49)mL/(100 g·min),C组最低为(122.55±18.59)mL/(100 g·min),降低比例依次为8%、18%、30%。与A、B两组比较,C组肾皮质RBF值明显降低(P均<0.05),降低比例分别为23%、14%。B组与A组相比,肾皮质RBF值降低(P均<0.05),降低比例为11%。肾皮质RBF值与血清肌酸酐(serum creatinine,Scr)呈负相关(r=-0.429,P<0.001),而与eGFR呈正相关(r=0.377,P<0.001)。肾皮质RBF值鉴别健康志愿者与T2DM的AUC值为0.651(95%CI:0.520-0.768);鉴别T2DM与DKD的AUC值为0.734(95%CI:0.619-0.829);鉴别早期DKD与中晚期DKD的AUC为0.760(95%CI:0.580-0.891)。结论ASL成像可无创定量评估肾脏血流灌注变化,且根据RBF减低可有效评估T2DM患者病情进展程度,有望成为无创评估T2DM患者肾功能损害的有效影像检查方法。Objective:To explore the correlation and clinical value of arterial spin labeling(ASL)in quantitatively evaluating renal blood flow(RBF)and renal injury in patients with type 2 diabetes mellitus(T2DM).Materials and Methods:Prospective recruitment of T2DM patients with varying degrees of renal function impairment was conducted.The patients were grouped based on the presence or absence of proteinuria and the estimated glomerular filtration rate(eGFR).Group A included T2DM patients without proteinuria,group B consisted of patients with proteinuria and eGFR≥60 mL/(min·1.73 m²),representing diabetic kidney disease(DKD)stagesⅠ-Ⅱ,and group C comprised patients with 15 mL/(min·1.73 m²)≤eGFR<60 mL/(min·1.73 m²),representing DKD stagesⅢ-Ⅳ.Healthy volunteers were included as a control group.Dual-kidney routine MRI scans and ASL scans were performed to obtain RBF values in the cortical region of both kidneys.Additionally,biochemical indicators such as renal function and urine analysis were collected.Statistical analysis was conducted to compare the differences in cortical RBF values among the groups and assess the correlation,sensitivity,and optimal diagnostic thresholds of the relevant indicators.Results:No significant difference in cortical RBF values was found between the left and right kidneys(all P>0.05).There was a significant overall difference in cortical RBF values among the four groups(all P<0.001).Compared to the control group(174.28±23.89)mL/(100 g·min),group A exhibited a decrease to(159.66±28.54)mL/(100 g·min),group B decrease to(142.16±19.49)mL/(100 g·min),and group C showed the lowest value at(122.55±18.59)mL/(100 g·min).The reductions in RBF values for groups A,B,and C were 8%,18%,and 30%,respectively.Group C had a significant decrease in cortical RBF values compared to groups A and B(both P<0.05),with reductions of 23%and 14%,respectively.Group B also had a significant decrease compared to group A(P<0.05),with a reduction of 11%.Cortical RBF values showed a negative correlation wit

关 键 词：糖尿病 2型 糖尿病肾病 肾血流量 磁共振成像 动脉自旋标记 

分 类 号：R445.2[医药卫生—影像医学与核医学] R587.2[医药卫生—诊断学]